LTD Claims Examiner

RO Portland ME
South Portland, ME 04106, USA

At One America Financial, our purpose is to create more certainty for our customers that leads to better moments, every day. Our commitment is to advance stability and growth in every solution and relationship. We deliver financial strength that builds for generations, and we are always aspiring, looking ahead, and collaborating to achieve more, together. Come be a part of this journey with us as we champion lives!

Job Summary

LTD Claims Associate is responsible to contribute to the overall success of One America's objectives by providing timely and accurate support to our customers and the claims department. The associate is responsible for reviewing the content of a claim file to determine if all pertinent information is available to perform a complete and accurate determination of the over payment. Upon completion of the file review, the associate determines whether additional follow-up with both internal and external customers may be necessary to acquire missing documentation/information.

Once a file is complete and an over payment has been determined by the associate, the associate works directly with the claimant or advocate, primarily on the phone, to ensure that over payments are recovered timely and in accordance with the specific policy language. This is a highly goal-oriented role; the associate is responsible for significantly contributing to the unit's overall recovery results.

The associate's complexity of files increases as he/she attains a strong knowledge base which is necessary to effectively administer recovery of over payments on multiple products and systems.

We are currently seeking Level I experience.

Primary duties may include, but are not limited to:

• Analyze content of claim file and obtaining the necessary financial and benefit information (that may not be immediately apparent) from colleagues, customers and external resources to determine appropriate course of action on each file.
• Consistently calculates, communicates and manages a caseload of claims with varying levels of complexity, demonstrating a strong technical ability necessary to administer over payment claims across multiple products and system applications.
• Negotiates and binds the Company with respect to decisions made regarding appropriateness of pursuing over payments.
• Thoroughly and accurately documents and codes financial recovery actions in claim system with supporting rationale for actions and next steps.
• Secures a professional relationship with the claimant, provides excellent customer service, demonstrates empathy and remains open to new information. Provides prompt, accurate, and courteous responses to customers to promote the One America brand.
• Participates in special projects and other assignments as needed.
• Customer Experience and support:
  • Effectively, accurately and timely communicates and collaborates with internal and external customers in accordance with departmental customer service protocols.
  • Demonstrates ability to accurately, collect and analyze over payment information to determine applicable next steps resulting in recovery of outstanding over payment in accordance with policy/contract provisions, regulations, and department procedures.
  • Appropriately learn and grow critical thinking skills, problem solving measures and discretion to obtain and/or clarify information with limited leadership oversight.
• Performance and Service expectations:
  • Actively delivers results and contributes to and maintains or exceeds departmental deadlines, requirements, service, accuracy, timeliness, and performance standards. The Overpayment/Financial Recovery Specialist I will take appropriate action to achieve objectives and will with limited leadership assistance…